How US Primary Care Is Falling Behind the Developed World

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As America continues to age, many U.S. primary care physicians swamped by older patients fear that their practices are inadequate to fully treat and counsel the sickest and frailest patents, according to a new survey by the Commonwealth Fund.

Nearly one in four primary care doctors – internists, family physicians, geriatric specialists and others – said their practices are not equipped to manage care for patients with multiple chronic conditions, such as heart and lung disease and diabetes, according to the study by the philanthropic and research organization.

Moreover, 84 percent said their practices lacked the training and experience to manage the care of patients with severe mental health problems, such as dementia and Alzheimer’s – a fatal disease that effects more than 5 million senior Americans. Nor do some of them feel well equipped to advise patients and their families on the need for long-term home care or community based social services.

These were some of the findings of the survey of doctors in 10 industrialized countries, including the U.S. and Canada. The physicians were asked to compare their experiences in providing care to patients with complex problems, using health information technology, and coordinating care outside of office.

Although the U.S. has a younger population than many other developed countries, the study notes, “The U.S. has a higher share of patients with multiple chronic conditions, severe mental illnesses and other significant health care challenges.”

As a group, these older, sicker patients constitute a disproportional share of health care spending in this country, and yet they do not fare well – in part because the nation’s primary care practices are ill prepared to meet their needs,” the study asserts.

Although the U.S. population is rapidly aging and in need of quality medical treatment, fewer and fewer medical students are choosing to become primary care physicians – opting instead for better-paying specialties.

According to a recent survey by the Kaiser Family Foundation, there are a total of 435,084 general practitioners in the U.S., including 179,040 practicing internal medicine, 127,756 in family practices and just 1,188 in geriatrics.

By one estimate, only 30 percent of all physicians in the U.S. are practicing primary care medicine. Meanwhile, there were more than 44 million people 65 and older in 2013, or 14 percent of the overall population, with estimates that number will grow to 98.2 million by 2060 – or one in four Americans.

“If it were properly staffed and compensated and strengthened, primary care could play a major role in helping to improve quality and control costs going forward,” Eric C. Schneider, a senior vice president for research at Commonwealth Fund and co-author of the study, said in an interview Tuesday. “But it’s really going to take an investment in strengthening primary care.”

“We have a system that is very heavy on specialist care but not primary care, so we don’t have a sufficient number of primary care doctors,” said John Rother, president and CEO of the National Coalition on Health Care. “And we have the baby boomers adding to Medicare at the rate of 10,000 every day. And the boomers are now getting to their 70s, when multiple conditions become common.”

“So that’s not a good picture,” he added. “It’s a mismatch between the need and the ability to deliver the appropriate care.”

Researchers analyzed survey responses from more than 11,000 primary care doctors in Australia, Canada, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. The doctors were asked to assess how well prepared their practices were – in terms of training and organization to meet the challenge of treating older patients with complex health care problems.

Physicians in the Netherland and Germany indicated they were the most confident in their ability to meet their patients’ needs, with only 12 percent saying they felt unprepared.

By contrast, many U.S. doctors interviewed conceded their practices were behind in training and could do a lot more for older patients in terms of responding to emergencies, steering them to the right specialists or simply following up with patients after they are discharged from a hospital.

For instance, only one in three primary care doctors interviewed said they were notified when one of their patients was discharged from the hospital or seen in an emergency room, according to the report. By contrast, 69 percent of doctors in the Netherlands – the country with the best overall performance – reported that they were always notified at the time of their patients’ release.

“Across most countries, about half of doctors said their practices routinely coordinate care with home care providers,” according to the study. “In the U.S., just over 40 percent reported communicating with social service providers on issues related to housing, meals, and transportation, compared with 65 percent of practices in the United Kingdom.’

One of a doctor’s more important responsibilities is to serve as quarterback for their patients in arranging for referrals and responding to crises. However, according to the Commonwealth Fund survey, slightly less than 40 percent of U.S. primary care doctors had arranged for patients to receive after-hours care without going to the emergency room.

That was the lowest rate in the survey – in contrast with 94 percent in the Netherlands, 92 percent in New Zealand, and 89 percent in the United Kingdom.

Washington Editor and D.C. Bureau Chief Eric Pianin is a veteran journalist who has covered the federal government, congressional budget and tax issues, and national politics. He spent over 25 years at The Washington Post.